Appendix 7
Guidelines and Procedure for the Safe Administration and
Management of Medicines
1.
INTRODUCTION
1.1
This procedure must be read in conjunction with the Policy for the
Administration of Medication and the Medication Administration Training
Pack for Domiciliary Care Assistants.
1.2
This procedure promotes the safety and well being of the service user and
provides a framework of safe practice for the Care Worker.
1.3
This procedure must be followed when Care Workers are required to assist
with medication, or administer medication to service users who are not
able to manage their medication themselves. This requirement will be
stated in the Service Delivery Plan as a level B or C
2.
OBTAINING PRESCRIPTIONS AND DISPENSED
2.1
Obtaining prescriptions – If the personal plan of care requires a repeat
prescription to be ordered, the Care Provider will indicate on the Service
Delivery Plan that 5 days prior to expiry of the MAR chart, the Care Worker
is to order /MAR chart from the GP/Pharmacist. Care Worker must not over
order or stockpile .
The Care Worker:
• must clearly indicate on the repeat request slip only which
medicines are required
• must take into account the expiry date of the MAR chart and order
from the GP/Pharmacist – 5 days
• the Care Worker must only use the service users preferred
Pharmacy which will be documented on the personal plan of care
(NB the chosen Pharmacy must be able to provide a MAR chart to
allow Level C administration by Care Workers)
2.2
Obtaining dispensed medication – In cases where the service user or
service users’ representative is unable to obtain dispensed medication, one
of the following methods of obtaining medication will be documented in the
Service Delivery Plan:
• the prescription requires collecting from the surgery and taking to the
Pharmacy for dispensing
• the Pharmacy will collect the prescription from the surgery and the
dispensed medication should be collected from the Pharmacy
• the Pharmacy will collect the prescription from the surgery and
arrange delivery of the dispensed medication to the service users’
home
Where the care provider is responsible for obtaining supplies of medicine on
behalf of the service user, the Care Worker should check that there is enough to
last for the next few days and to order medicines as agreed in the Service
Delivery Plan. All unused regular and refused medication should be returned to
the Pharmacy at the end of the month. HOWEVER, all ‘as required’ medication
which is unused should be retained and used as directed on the new replacement
MAR chart. This should be documented in:
Level C: the Medicines Administration: Additional Information Record
Level B: Record Book
It is important not to over-order medicines. Before ordering, the Care Worker
should check the amount of medicines the service user has and only order what
is required rather than every item. Particular care should be taken when ordering
‘as required’ medications.
Running out of a medicine because of ‘bad housekeeping’ should not be
an excuse to contact emergency services.
3.
STORAGE OF MEDICINES
3.1
Medicines must be stored in a cool, dry place unless otherwise stated on
the label (for example some medicines must be stored in a fridge).
3.2
All medicines must be kept out of the reach of children.
3.3
Locked boxes will be provided (while current stock lasts) via the Medicine
Management Nurse to those service users at high risk of over medicating if
they have free access to their medications. However, it will be the
responsibility of the Provider service to supply locked boxes (standard 10.6
of the National Minimum Standard). Other service users will be asked to
provide a suitable sized lidded box e.g. plastic food storage container, shoe
box etc. These boxes will be used to store the medication and MAR chart.
Any special storage instructions for medicines will be identified on the label
and should be followed e.g. keep in fridge.
In certain cases where a service user has particularly large numbers of
medicines, a second lockable box may be needed to store spare stock,
particularly during the period of overlap where repeat medications arrive
as the remaining previous stock is still being used up. In such cases the
second box should be clearly labelled as box 2 Spare Stock, and noted on
the Service Delivery Plan. To minimise the need for this, please ensure
medicines are not over ordered.
3.4
It is advisable that medicines should not be stored in kitchens or
bathrooms due to high temperature and humidity. (Unless to do so would
significantly cause the service user to become confused and so lose
independence).
3.5
Medicines must be kept in their original container as provided by the
Pharmacy and must not be removed until the time of administration. This
means that doses of medicines should not in general be put out in advance
of administration in egg-cups or medicine pots as it can lead to accidental
mix-ups and errors. However, it may be appropriate for a service user to
have access to medicines in between care calls, e.g. sleeping tablets or
medicines for pain relief. In such circumstances doses may be left out for
that individual to take at a later time. This can only be undertaken where it
has been risk assessed as appropriate, agreed with the service user, and
it is documented in the Plan of Care. Doses administered ‘4 later’ are
recorded on the MAR with the number 4 instead of the Care Worker’s
initials. The next Care Worker to visit should check that this ‘4 later’
medication has been taken by the service user. Where the service user has
not taken this medicine, the Care Worker must dispose of them as they
would for any refused medication (see ‘Disposal of refused medication’
page 18), and this should be recorded on the Medicines Administration:
Additional Information Record.
Medication Administration Procedure
Level B administration:
Reminding
1. Introduce yourself to the service user
2. Check the Service Delivery Plan for instructions on medication
3. Remind the service user to take their medications and observe that they
carry this out.
4. The exact assistance given on each visit should be documented in the
Neath Port Talbot Medication Record Book.
Assisting
1.
2.
3.
4.
Introduce yourself to the service user
Check the Service Delivery Plan for instructions on
Discuss with the service user their medication requirements.
Taking directions from and in the full view of the service user, give
assistance to the service user as requested by them.
5. Ensure that the service user is able to remain in control of their own
medication.
6. The exact assistance given on each visit should be documented in the
Neath Port Talbot Medication Record book.
NB. If at any time you feel that the service user is not aware of the medication
they are taking STOP ASSISTANCE AND PHONE YOUR LINE MANAGER FOR
ADVICE AND REASSEMENT.
Level C administration using a dosette box (MDS)
1. Introduce yourself to the service user
2. Ensure the environment is free of distractions e.g. ask the service user to
turn the television off if this helps you to concentrate better
3. Check Service Delivery Plan for instructions on medication
4. Choose the appropriate compartment, remove tablets and give to the
service user to take. Record medication given from dosette box in the NPT
Medication Record Book. There will be no requirement for a MAR chart
Level C administration using a MAR Chart and original containers
1. Introduce yourself to the service user
2. Ensure the environment is free of distractions e.g. ask the service user to
turn the television off if this helps you to concentrate better
3. Check Service Delivery Plan for instructions on medication
4. Explain that you will need to check the medication to see if any is to be
given prior to food.
5. Find a clean area free from clutter
6. Open medicines box - ask service user if they have taken any medication
already and check the MAR chart to ensure that none of the medicines
have already been given/signed for. If you have reason to believe
medicines have been taken already STOP PROCEDURE and inform line
manager. Other wise continue as follows:
7. Remove all medicines from the box, checking as you do that they all
have the service user’s name on them.
8. Assemble all of the equipment needed to administer the medication such
as 5ml spoon, MAR chart, , gloves etc.
9. Organise the medications as follows:
Using the MAR chart in conjunction with the labels on the medication
boxes, go through each checking the five rights (Right Service user, Right
time, Right medicine, Right dose, Right route), ensuring that the
instructions on the MAR and labels match.
Check the label for any special instructions before administering the
medicine e.g. does it need to be taken before or after food? Should the
service user avoid alcoholic drink? Does the medicine need to be dissolved
or mixed with water before taking? Should it be swallowed whole not
chewed? Etc. Please ensure that these additional instructions are followed.
Some medicines should only be taken “when required” to relieve
symptoms e.g. pain killers, laxatives, sleeping tablets, inhalers, GTN spray
for angina. The service user will need to be asked whether they need these
medicines and they should not be given routinely. (If you are not sure
what a “when required” medicine is for, please consult the patient
information leaflet insider the medicines container or contact the
Community Pharmacist.
As you are doing the above, place the medicines as follows:
•
•
•
•
•
Medication to be taken before food -placed to one side on the lid.
Medication to be taken with or after food -on the other side of
The lid, along with any other to be taken at this time.
Medication not required at this call – placed inside the box out of
the way.
Where there is more than one container of the same put spare
containers into the box and the pack to be used on the lid
Any medication that needs further clarification: place this in the box
and make an immediate written note to contact line manager, Community
Pharmacist or out of hours services (as appropriate) for further
information.
If you always do this the same way then if you become distracted for
any reason it is easy to see where you have got to. Always use the
MAR chart AND the medication boxes as your point of reference. (if
then for any reason you have missed something it will be left outside of the
box for you to clarify)
Wash and dry hands and put on gloves
Before administering, check any expiry dates highlighted on the label e.g. for
eye drops and liquids. Also check when removing strip from the box that the
name of the drug on the strip matches that on the container.
10. Following the MAR chart AND the boxes administer any medication that
should be given before food, one medicine at a time, and sign the
MAR chart after each is administered.
11. Continue to assist with other activities, such as personal care, and if
more medicines are to be taken after food, ensure that service user has
something to eat.
12. Wash and dry hands and put on gloves
13. Following the MAR chart AND the boxes administer any medication that
should be given after food, one medicine at a time, and sign the
MAR chart after each is administered. NB with ‘As Required’
medicines, ask the service user whether they need these medicines as
they should not be given routinely.
14. Once all medication has been administered check that no boxes/bottles
are left over, wash and dry any utensils, and return everything to its
original place ensuring box is locked (if appropriate).
Refusal
The Care Worker must never force a service user to take medication. However,
if they are refusing a medicine it is useful to ask them why they do not wish to
take it, as this may need to be discussed with GP. The health of the service user
may be affected if medication is not taken. It is recommended that the Care
Worker seeks advice from the Pharmacist either directly or via the Care Worker’s
line manager. Any advice given will be recorded.
1. If the service user refuses the medication, record this on the MAR chart
using the appropriate code indicated at the bottom of the chart (this may
be different for each Pharmacy)
2. If medication has not been removed from the original container then leave
in place.
3. If medication has been removed from the original container then place in
the refused/dropped bottle which should then be returned to the Pharmacy
at the end of each month for disposal.
4. All changes in the service user’s condition including refusal of regular
medication should always be reported to Service users GP (This does not
apply to refusal of medicines which are taken only when required).
REMEMBER
DO NOT administer medicines from unlabelled containers.
For Level C service users DO NOT administer dosette boxes (MDS) that have
not been filled by a Pharmacist
If you are in doubt about anything, DON’T administer and seek advice